Prognosis and prognostic research: what, why, and how?

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Abstract
Doctors have little specific research to draw on when predicting outcome. In this first article in a series Karel Moons and colleagues explain why research into prognosis is important and how to design such research Hippocrates included prognosis as a principal concept of medicine.1 Nevertheless, principles and methods of prognostic research have received limited attention, especially compared with therapeutic and aetiological research. This article is the first in a series of four aiming to provide an accessible overview of these principles and methods. Our focus is on prognostic studies aimed at predicting outcomes from multiple variables rather than on studies investigating whether a single variable (such as a tumour or other biomarker) may be prognostic. Here we consider the principles of prognosis and multivariable prognostic studies and the reasons for and settings in which multivariable prognostic models are developed and used. The other articles in the series will focus on the development of multivariable prognostic models,2 their validation,3 and the application and impact of prognostic models in practice.4 #### Summary points Prognosis simply means foreseeing, predicting, or estimating the probability or risk of future conditions; familiar examples are weather and economic forecasts. In medicine, prognosis commonly relates to the probability or risk of an individual developing a particular state of health (an outcome) over a specific time, based on his or her clinical and non-clinical profile. Outcomes are often specific events, such as death or complications, but they may also be quantities, such as disease progression, (changes in) pain, or quality of …